maternal morbidity

Mamas on Bedrest: Mamas Making a Difference

April 15th, 2013

Mamas, you can make a difference-right from your beds!!

I know, you are probably thinking,

“What the heck could I possibly do? I’m on bed rest. I have all that I can handle right now.”

I hear you, mamas. I know that your utmost concern is first and foremost for your own health and for the health of your unborn child. But isn’t that what all mamas want??

This weekend I went to a clothing swap to raise funds for the “Train 1000 Midwives” program for the Edna University Hospital in Somaliland Africa. The Edna University Hospital was established in Hargeisa, Somaliland following the bloody, brutal civil war in Somalia. After the war, the newly established Republic of Somaliland was left with a war torn country and no public help or services. Edna Adan Ismail, former minister to Somaliland and current President of the Organization for Victims of Torture,  is a leading activist for women’s health rights in Somaliland and she speaks vehemently against female genital circumcision/female genital mutilation. She established the University Hospital in the hopes that those trained there will return home to their native towns and villages and care for their people. The “Train 1000 Midwives” Program is a direct response to the extremely high rate of maternal and infant mortality in the region.

“Train 1000 Midwives” is one of the projects selected by Connecther.org for funding. Connecther.org’s vision and mission are:

VISION:

Connecther seeks to end global poverty by partnering with donors, non-profits and other stakeholders that focus on aiding women and children in their quest for self reliance.

MISSION:

Connecther provides a platform for matching donors to projects that provide poverty alleviation services to women and children in their quest for self-reliance. Connecther helps our project partners raise funds and awareness via our communications & crowdfunding platforms insuring that Givers’ contributions are invested to make the biggest positive impact.

Connecther is an amazing organization and at it’s core is a group of women who have decided to come together and make a difference. It’s that simple. Women, more specifically Mamas, have come together and are essentially saying,

‘It’s no longer acceptable for women and girls to suffer and struggle.  Those women and girls who are so inclined to do better we are going to help them by providing funds for necessary resources.’

It’s that simple to get involved. It’s that simple to be “Pro-Active”. The Clothing Swap was sponsored by The Lucky Penny Fund. Inspired by Half The Sky, a movement intent on exchanging women’s oppression into opportunity, friend and colleague Jessica Sunshine Christian started the Lucky Penny Fund as a way to learn more about the lives of women around the world and to help. She admits that she doesn’t have much to give, but she is willing to give from what she has-one penny at a time. Jessica and her partner Carmen pooled their energy and resources to organize the clothing swap. We each cleaned out our closets and for $25 essentially “went shopping”. Our donations went to the “Train 1000 Midwives” project via Connecther and the remaining items not swapped were donated to a local women’s shelter. This was win-win-win -win!!

So often we learn of events or people in the world and think, “That’s so sad” or, “That’s tragic”. Yet the moment passes because we feel impotent to effect change. Mamas can change the world and all of the organizations mentioned above are in existence because mamas have said, “Enough is enough! I may not be able to do much, but I can do what I can!!”

That’s all it takes! That’s what it means to be “Pro-Active!” So mamas, even if you are on bed rest, consider what you can do to ease the burden of another mama; donate funds, subscribe to a newsletter, volunteer, be a peer supporter (Lots of this on our Facebook Page!). Any little bit helps.

 

Mamas on Bedrest: Research and Practical Efforts Aimed At Improving Maternity Care!

April 12th, 2013

Hello Mamas,

I have to confess, I’m having a moment of Geek. I received an article link from a former Mama on Bedrest and the Geek in me has been jumping up and down as I am reading it. Finally, researchers here in the United States are taking notice of the fact that intra partum maternal mortality rates are atrocious and they are doing something about it!

Now you are probably saying, “What has that got to do with me, a Mama on Bedrest?” Well, it has everything to do with you! It means that physicians, researchers and hospitals around the country are making changes to ensure that if you have a complication during your labor and delivery, you don’t die from it. In my book, that’s a pretty big deal!

Okay, this is not exactly a sexy topic. It’s not, “4 Ways to better prop yourself up on pillows while on bed rest,” or some other topic that is immediately associated with your current situation. It’s not soothing, it’s not comforting. Yet it’s extremely important. It’s the nuts and bolts of maternity care. Its looking at a grave situation-maternal mortality in the United States (which is worse than any other industrialized nation by the way  and 3-4 times worse in African American women!)-and saying, “We’re going to fix this!!” The good thing is that when American physicians and researchers put their minds and energy into improving outcomes, things typically do improve! (Look at how care of preterm infants has vastly improved, assisted reproductive technology allows women to become pregnant in the first place, and all the advances in perinatal care if you want examples!)

So what is the article saying-Exactly?

The article is from the St. Louis Post Dispatch and asked the question, “Why are so many US women dying during childbirth?” The doctors and researchers in this article, all from the St. Louis Missouri area, began looking closely at cases of maternal intra partum death and came up with the following reasons and solutions:

  • Preconception counseling or at least very early prenatal counseling is important-especially in women with pre-existing conditions and/or riskfactors for complications.
  • Pregnancy has become increasingly risky because of  the prevalence of obesity, Type 2 diabetes, hypertension and cardiovascular disease; more older women having children; advancements in fertility treatments resulting in twin births; and the high rate of C-sections. All of these issues must be addressed early and aggressively, from start to finish during pregnancy.
  • Researchers and high-risk pregnancy specialists say an important step is stratifying maternity care, parallel to what has been adopted in the care of high-risk newborns. Higher-level hospitals would have the specialists and infrastructure needed to take care of complex (maternal health) cases, help institute guidelines to improve care, and consult with lower-level hospitals on complex cases. They note that often a mama and her baby are transferred to another hospital to care for a sick, fragile infant, forgetting that the infant is ill because the mama is also in poorer health. Care must start with mama!!
  • Physicians and hospitals must be continually evaluating their outcomes and making adjustments to improve care. Complication protocols must be instituted and everyone must be trained in these protocols. Doctors and staff who fail to comply must be “reined in.”
  • What hospitals can also do, many say, is promote spontaneous, vaginal births — the safest for mothers and babies. One procedure or drug increases the risk for another, often causing a cascade of interventions that ends with a C-section. In the U.S., the C-section rate has skyrocketed to 33 percent of all births. The World Health Organization says it should be closer to 15 percent.
  • Consider using more Midwives and for uncomplicated births. Their low-tech approach has been shown to reduce C-section rates and improve other health outcomes.
  • More research and study needed to understand the causes and treatments of potentially catastrophic maternal conditions. Even if a complication is rare, there should be protocols in place  every part of the health care team should be educated on the condition and the protocol and know what to do in the event of a catastrophic event.
  • Statewide maternal mortality review committees (and a national registry??) made up of key players in prenatal, childbirth and postpartum care are being instituted. Committees regularly review deaths to gain insight on warning signs, prevention and treatments. Such committees exist in Illinois and Missouri and the Illinois committee is the model for several other committees forming around the country. Federal legislation proposed two years ago to beef up state maternal mortality committees stalled, but nationally, there is a bigger effort around improving care than there ever has been before by government, doctors groups and researchers.

The wheels of change are slowly turning and finally there is emphasis on the health of mamas! I’ve said my goal is to put myself out of business. Hopefully with these changes in maternity care, that desire is not long off!

Mamas on Bedrest: $5 Billion on Moms and Babies!

January 9th, 2013

$5 Billion dollars.  Yes that’s Billion with a “B”.  That is the amount of money that the United States could potentially save annually on medical costs related to maternity care according to  The Cost of Having a Baby in the United States, new study published by Childbirth Connection, Catalyst Payment Reform and Center for Healthcare Quality and Payment Reform. The study was prepared by Truven Health Analytics and released January 7, 2013.

It’s no secret that the US healthcare system is in deep trouble and if it continues in its current iteration, it could very well bankrupt the entire country in the not too distant future. With the passage of the Affordable Care Act, the federal government made an attempt at reducing costs while at the same time making health insurance more available to more Americans. But it is safe to say that no one thinks that the ACA in its current form will be the answer to all that ails our flailing healthcare system. In an attempt to see where there are potential cost savings, several different agencies (public, private and non-profit) have undertaken studies to evaluate the type and quality of care provided in the United States in different health care arenas. In this study, maternity costs were analyzed in an effort to determine where there are not only potential cost savings in maternity care, but also potential reductions in risks to maternal and fetal/infant health.

The study is presented in an 86 page document.  One of the most remarkable findings is the fact that there are roughly 4 million babies born in the US annually and now a full one third or 33% are born via Cesarean section. This represents a 50% increase in cesarean deliveries in the last decade, and many cesareans performed are not medically necessary. Unnecessary  cesarean sections have been shown to increase health complications for both mother and baby.  But what was found in this study is that cesarean sections dramatically increase the cost of maternity care. According to the study,

“For the commercially insured, the average cost of a birth by c-section in 2010 was $27,866, compared to $18,329 for a vaginal birth.  Medicaid programs paid nearly $4,000 more for c-sections than vaginal births.  If the rate of c-sections were reduced from 33% to 15% (the World Health Organization recommends a c-section rate of 15% or less), national spending on maternity care would decline by more than $5 billion.”

The study also found that the cost of care for mamas increased 40% from 2004-2010 and this did not include costs of infant care, and also noted wide variation in costs from state to state and within states.  According to Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform (CHQPR),

“Maternal and newborn care together represent the largest single category of hospital expenditures for most commercial health plans and state Medicaid programs, so reducing maternity care costs provides a major opportunity to reduce insurance premiums for employers and to make Medicaid coverage more affordable for taxpayers.”

Another startling finding (in my opinion) is the fact that the uninsured may be charged. According to the study,

“Uninsured parents could be charged over $50,000 for a baby born by c-section and over $30,000 for a baby born by vaginal birth.  Average provider charges for a c-section in 2010 were $51,125, but commercial insurance plans only paid $27,866, 55% of what an uninsured patient could be asked to pay.”

Other startling findings:

  • Vaginal births cost $18,329; c-sections cost $27,866 (for the commercially insured, 2010) and these costs are substantially more for the uninsured.
  • Medicaid, which pays for over 40% of all births, paid nearly $4,000 more for c-sections than vaginal births.
  • If the current national rate of c-section were reduced from 33% to 15% (the World Health Organization recommends a rate of 15% or less), we could save $5 billion!
  • The cost of maternal care (not including newborn care) jumped an incredible 40% between 2004 and 2010 for the commercially insured.
  • The total commercial payments for care of newborns were $5,809 for babies delivered vaginally and $11,193 for cesarean births.  Total Medicaid payments for newborn care were $3,014 for vaginal births and $5,607 for cesarean births.  Reducing the rate of prematurity among infants could significantly reduce these costs.
  • The largest share of all combined maternal-newborn costs goes to pay for hospital or other facility costs regardless of the type of birth.  59% of total maternal and newborn care costs for vaginal births are used to pay facility fees, and 66% of costs for c-sections are for facility fees.  Similarly, the hospitalization phase of childbirth consumed from 70% to 86% of all maternal and newborn care costs, depending on payment source and type of birth.
  • There is significant variation in cost within and across states.

If the United States is serious about health care reform, obviously maternity care reform has to be at the top of its list! If pulling the US cesarean section rate in line with World Health Organization recommendations would truly result in a savings of $5Billion dollars, we should be seriously looking at ways to reduce the number of cesarean sections performed. Likewise, since hospital fees represent more than 70% of maternity care costs, it behooves us as a nation to consider increasing the availability and accessibility of birthing centers and, for those low risk women, home births. Many other countries utilize nurses and other health care providers to provided additional care to mothers and babies in their homes before and after birth (The models upon which Mamas on Bedrest & Beyond is designed!) which has been shown to greatly reduce the numbers of hospital admissions and care costs. The US has the means, the skills and expertise and the workforce (talking about A LOT of potential jobs here!) to provide such care and hence, further reduce the cost of maternity care and the burden on the US health care budget. If as a nation the US fails to implement of these recommendations, we will continue to face spiraling out of control maternity care costs, and,  more tragically, more perinatal complications, catastrophes and deaths of mamas and babies.

Childbirth Connection is a national not-for-profit organization founded in 1918 as the Maternity Center Association.  Its mission is to improve the quality and value of maternity care through consumer engagement and health system transformation.

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other healthcare purchasers to catalyze improvements in the way healthcare services are paid for and to promote better and higher value care in the United States.

The Center for Healthcare Quality and Payment Reform is a national policy center that encourages comprehensive, outcome-driven, regionally-based approaches to achieving higher-value healthcare.